Patient Forms

General Forms

• Authorization for Medical Treatment and Financial Responsibility 
• Authorization for Release of Records 
• CPAP Instructions 
• General Health Questionnaire 
• Health History 
• Health Questionnaire 
• Media Authorization Form 
• New Patient Questionnaire 
• Outpatient Preoperative Instructions 
• Preoperative Instructions for Outpatient Surgery 
• Preoperation Instructions for Surgery 

Evaluation for C6/C7 Spinal Cord Injury

• See web page on Center for Nerve Injury and Paralysis website 

For Patients of Dr. Ida Fox

• Authorization for the Use or Disclosure of Protected Health Information 
• Health Questionnaire 
• Preoperative Instructions 

For Patients of Dr. Susan Mackinnon

• Pain Questionnaire
• Patient Health Survey 
• SF-8 Health Survey 
• Secret to Losing Weight 

For Patients of Dr. Thomas Tung

• Preoperative Instructions for Outpatient Surgery 

For Resident Cosmetic Clinic Patients

• Important Facts 
• Preoperative Instructions for Surgery 

Patient Care Instructions

• Care of Cast 
• Care of Nipple Tattoo